Age, tumour size predict post-TACE complications in HCC patients

In patients with hepatocellular carcinoma (HCC), most complications following transarterial chemoembolization (TACE) involve minor postembolization syndrome, reveals a study presented at EASL 2023. The incidence of major complications is high at 25 percent, with a 1.8-percent death rate.

Additionally, older age is associated with the risk of developing acute kidney injury (AKI) and acute liver decompensation. A bigger tumour size also increases the risk for infection, while Barcelona Clinic Liver Cancer (BCLC) stage B contributes to the development of acute liver decompensation.

“Risk factors in developing major complications include older age, larger tumour size, multinodular tumour, and longer prothrombin time,” said the researchers, led by Dr Melissa April Pajinag from St Luke’s Medical Center in Quezon City, Philippines.

Presently, analyses on the risk factors from complications after TACE in patients with HCC are lacking. To address this, Pajinag and her team investigated the incidence and risk factors in developing infection, AKI, and acute liver decompensation in this population.

All adult patients with HCC who underwent TACE from January 2013 to October 2022 were included in this retrospective cohort study. The researchers performed univariate and multivariate analyses to identify the factors associated with infection, AKI, and acute liver decompensation.

Risk factors for complications

Overall, 318 patients had undergone TACE, of which 220 were included in the analysis. Major complications occurred in 56 patients (incidence rate, 25.45 percent). Nearly half (43.2 percent) of these cases were treated as postembolization syndrome, while 11.8 percent were infections, 9.1 percent acute liver decompensation, and 4.5 percent AKI. [EASL 2023, abstract THU-157]

Four patients succumbed to the disease (mortality rate, 1.8 percent).

Patients with larger tumour size (odds ratio [OR], 0.19, 95 percent confidence interval [CI], 0.05‒0.69; p=0.03) were at greater risk of developing infection, while those with older age were more likely to develop both AKI (OR, 1.09, 95 percent CI, 1.00‒1.18; p=0.10) and acute liver decompensation (OR, 1.08, 95 percent CI, 1.02‒1.14; p=0.02).

In addition, BCLC stage B significantly correlated with AKI development (OR, 0.08, 95 percent CI, 0.01‒0.95; p=0.09).

On multivariate analysis, the following risk factors independently contributed to major complications after TACE: older age (OR, 1.06, 95 percent CI, 1.02‒1.11; p=0.01), larger tumour size (OR, 0.34, 95 percent CI, 0.13‒0.90; p=0.07), multinodular tumour (OR, 5.64, 95 percent CI, 1.17‒27.18; p=0.07), and longer prothrombin time (OR, 1.50, 95 percent CI, 1.16‒1.95; p=0.01).

“TACE is used most often for the treatment of large unresectable HCC that are not amenable to other treatments or as a bridging therapy prior to liver transplantation,” the researchers said. “This procedure is generally well tolerated with an incidence of major complications post-TACE described as 2–7 percent with a risk of mortality estimated at 1 percent.”

Complications that tend to worsen the prognosis of HCC patients can be predicted by several risk factors. Identifying these factors can help clinicians select, stratify, and prepare patients for TACE, according to the researchers.